Multivariate Conditional Logistic Analysis Research Articles

Association Between Proton Pump Inhibitor Exposure and Acute Kidney Injury After Cardiac Surgery

ObjectiveTo evaluate the association of preoperative proton pump inhibitor (PPI) exposure with incident acute kidney injury (AKI) after cardiac surgery. Patients and MethodsThe Severance cardiac surgery cohort included 9860 cardiac surgery patients aged 18 years or older. The National Health Insurance Service-senior cohort included 2933 patients aged 60 years or older who underwent cardiac surgery. Preoperative PPI exposure was defined as a PPI prescription within 3 weeks prior to cardiac surgery. Primary outcomes were postoperative AKI and AKI requiring dialysis (AKI-dialysis). ResultsIn the Severance cardiac surgery cohort after propensity score matching for PPI exposure, incident AKI (44.0% [472 of 1073] vs 40.5% [1304 of 3219]) and AKI-dialysis (5.8% [62 of 1073] vs 3.7% [119 of 3219]) were more common in patients exposed to PPI than in those who were not. Hospital and intensive care unit stay durations were longer among PPI-exposed than PPI-nonexposed patients. Multivariable conditional logistic analyses revealed that PPI exposure was significantly associated with incident AKI (adjusted odds ratio [AOR], 1.21; 95% CI, 1.03 to 1.42; P=.02) and AKI-dialysis (AOR, 1.74; 95% CI, 1.15 to 2.63; P=.009). The National Health Insurance Service–Senior cohort had similar results, revealing a significant association between PPI exposure and incident AKI-dialysis (AOR, 1.87; 95% CI, 1.25 to 2.81; P=.003). Discontinuation of PPI prior to operation was associated with a lower odds of AKI development in both cohorts. ConclusionPreoperative PPI exposure may be a modifiable risk factor for AKI among patients undergoing cardiac surgery.

Lower serum copper concentrations are associated with higher prevalence of nonalcoholic steatohepatitis: a matched case–control study

Copper is an essential trace element involved in oxidative stress reactions and energy metabolism. While nonalcoholic fatty liver disease (NAFLD) is closely related to metabolic dysfunction, the role of copper in the development of simple steatosis (NAFL) and nonalcoholic steatohepatitis (NASH) is still unclear. We aimed to compare serum copper levels between patients with simple steatosis and those with NASH. We studied 102 patients with biopsy-proven NASH (cases) and 102 NAFL controls, who were matched for age, sex, and residential city. Multivariable conditional logistic analysis was performed to explore associations between serum copper levels and the presence of NASH. Serum copper levels were significantly lower in patients with NASH than in those with matched NAFL controls (15.53 ± 2.41 μmol/l vs. 16.34 ± 3.23 μmol/l; P = 0.029). This intergroup difference in serum copper levels was more pronounced in men than in women. The per unit, per SD, and per doubling of serum copper levels were associated, respectively, with an approximately 20, 40, and 90% decrease in risk of having NASH, even after adjustment for potential confounding factors. Lower serum copper concentrations are significantly associated with higher prevalence of NASH among biopsied-proven NAFLD patients, particularly in men.

Impact Mode of Delivery on Breastfeeding Practice Among Women Delivering in Maternity Teaching Hospital Sulaimani City

Background: Breastfeeding is a factor in the health of both the kid and the mother. However, research on how a manner of birth affects breastfeeding is scarce. Caesarean section rates are high, and breastfeeding rates are low, which are major public health problems in all developing countries. Objective: The study aimed to evaluate the impact mode of delivery on breastfeeding practices. Methods: A quantitative/prospective longitudinal study was conducted in a maternity teaching hospital from April 24 to October 5, 2021. The study included 215 patients, 105 of whom had a cesarean section and 110 of whom had a vaginal delivery. The participants were followed for two months after childbirth. A questionnaire was used to collect demographic information and the kind of delivery. In-person interviews were used to finish all of the subjects.Using SPSS version 24 software, researchers analyzed and interpreted data using descriptive statistical analysis, inferential chi-square test, and multivariate conditional logistic regression statistical analysis. Results: The study found that women who gave birth vaginally were more likely than those who had a cesarean section to breastfeed during the first hour following birth. In terms of skin-to-skin contact immediately after birth, rooming-in, the initiation of breastfeeding, from delivery to first breastfeeding duration, barriers to exclusive breastfeeding, and many lactations per day, there was a statistically significant difference between mothers who had vaginal deliveries and mothers who had caesarean deliveries. Conclusion: After two months of follow-up, the study found a statistically significant relationship between mode of delivery and breastfeeding practice.

Periconceptional use of cod liver oil, a vitamin D source, could decrease the risk of CHD in offspring.

To explore if there is association between vitamin D supplementation through cod liver oil ingestion around the periconceptional period and the risk of developing severe CHD in offspring. Furthermore, we would examine the interaction between vitamin D and folic acid supplementation in the association. A case-control study was conducted in Shanghai Children's Medical Center, in which, a total of 262 severe CHD cases versus 262 controls were recruited through June 2016 to December 2017. All children were younger than 2 years. To reduce potential selection bias and to minimise confounding effects, propensity score matching was applied. After propensity score matching, vitamin D supplementation seemed to be associated with decreased odds ratio of severe CHD (odds ratio = 0.666; 95% confidence intervals: 0.449-0.990) in the multivariable conditional logistic analysis. Furthermore, we found an additive interaction between vitamin D and folic acid supplementation (relative excess risk due to interaction = 0.810, 95% confidence intervals: 0.386-1.235) in the association. The results suggested that maternal vitamin D supplementation could decrease the risk of offspring severe CHD; moreover, it could strengthen the protective effect of folic acid. The significance of this study lies in providing epidemiological evidence that vitamin D supplementation around the periconceptional period could be a potential nutritional intervention strategy to meet the challenge of increasing CHD.

Qualitative and quantitative measures of prefemoral and quadriceps fat pads are associated with incident radiographic osteoarthritis: data from the Osteoarthritis Initiative

To determine if qualitative and quantitative measures of prefemoral fat pad (PFP) and quadriceps fat pad (QFP) are associated with incident radiographic osteoarthritis (iROA) over 4 years in the Osteoarthritis Initiative (OAI) study. Participants in this nested case-control study were selected from the OAI study with knees that had Kellgren Lawrence grades (KLG)of 0 or 1at baseline. Case knees were defined by iROA (KLG≥ 2) over 4 years. Control knees without iROA were matched 1:1 with case knees. Magnetic resonance images (MRIs) were read at P0 (time of onset of iROA), P-1 (1 year prior to P0) and baseline, and used to assess PFP (i.e., prefemoral hyperintensity alteration, patellofemoral hyperintensity alteration, maximum axial area) and QFP (i.e., hyperintensity alteration, mass effect, maximum axial area). Conditional logistic regression analyses were performed to study the associations between PFP/QFP measures and iROA, after adjustment for covariates. 354 case knees with iROA were matched to 354 control knees. 66.9% of the participants were female, with an average age of 60.1 years. PFP prefemoral hyperintensity alteration measured at three time points (OR [95%CI]: 1.46 [1.18-1.82], 1.50 [1.20-1.88], 1.52 [1.22-1.89] respectively), PFP maximum axial area (OR [95%CI]: 1.07 [1.01-1.14], 1.08 [1.01-1.15], 1.08 [1.02-1.15] respectively) and QFP hyperintensity alteration (OR [95%CI]: 1.59 [1.27-2.00], 1.44 [1.13-1.82], 1.38 [1.09-1.73] respectively) were significantly associated with iROA in multivariable conditional logistic analyses. QFP mass effect measured at BL and P-1 (OR [95%CI]: 1.42 [1.11-1.82], 1.33 [1.01-1.73] respectively) were significantly associated with iROA. Qualitative and quantitative measures of PFP and QFP are associated with increased iROA over 4 years.

Case-control study on risk factors for upper respiratory tract infection in hospitalized children with mental disorders

Objective To investigate the clinical characteristics of upper respiratory tract infection in hospita-lized children with mental disorders, and to analyze the risk factors for nosocomial infection, so as to provide reference for clinical treatment and prevention and control of nosocomial infection(NI). Methods The NI of 1 587 hospitalized children at the Second Affiliated Hospital of Xinxiang Medical University from January to December 2016 was investigated and a retrospective study was conducted on 78 hospitalized children with nosocomial upper respiratory tract infection.In a ratio of 12, the patients with mental disorders during the same time at hospital, without the occurrence of hospital infection, with same gender and same age group, were selected as the control group, then the univariate regression analysis and multivariate conditional Logistic regression analysis were carried out. Results Of the 1 587 cases, 86 cases were NI, and the incidence of NI infection was 5.42%.Among them, the upper respiratory tract infection accounted for 83.87%(78 cases). Univariate conditional Logistic regression analysis indicated that the type of disease, hospitalization days, insight, rehabilitation activities, hand hygiene habits, self-support ability, eating habits, management mode, seasonal and environmental conditions were the risk factors for upper respiratory tract infection in hospitalized children with mental disorders (all P<0.05). Multivariate analysis showed that the odds ratio(OR) of autumn and winter, poor self-support ability, no insight, poor hand hygiene habits, longer hospitalization days (over 14 d), severe mental illness were 19.627 (5.391-23.518), 12.835 (3.436-18.715), 5.427 (1.879-16.921), 3.752 (1.743-16.864), 3.618 (1.659-12.671), 3.361 (1.478-10.527), respectively, which were significantly associated with the occurrence of upper respiratory infection, and the differences were statistically significant (all P<0.05). Conclusions The season, self-support ability, insight, hand hygiene habits, days hospitalization, and disease type are the independent risk factors for upper respiratory infection in hospitalized children with mental disorders, positively controlling and eliminating of independent risk factors for upper respiratory tract may reduce its incidence in the inpationt children. Key words: Mental disorder; Hospitalized child; Nosocomial upper respiratory tract infection; Risk factor; Case-control study

Risk factors for Clostridium difficile infection in intestinal transplant recipients during the first year post-transplant.

Clostridium difficile is the most common cause of healthcare-associated infectious diarrhea. Risk factors for C.difficile infections (CDI) in intestinal transplant recipients (ITR) are not well-defined. The aim of our study was to assess specific risk factors for CDI in ITR. This is a 1:3 case-control study that included 29 ITR who developed CDI (cases) and 87 ITR without CDI (controls) observed during the first year post-transplantation. Wilcoxon rank sum and Fisher's exact tests were used to compare variables. Univariate and multivariable conditional logistic regressions analysis were performed to identify risk factors for CDI. The multivariable conditional logistic regression analysis showed that proton pump inhibitors (PPI) administration (odds ratio [OR]=0.06; 95% confidence interval [CI]: 0.007-0.52; P=.01) was the only factor associated with lower rates of CDI. Outcomes for cases vs controls: rejection episodes 24.14% vs 20.69% (P=.7), graft loss 0% vs 2.3% (P=.99), and survival rate 1year post-transplantation 79.3% (59.6-90.1%) vs 87.2% (78.1-92.7%) (P=.38). Proton pump inhibitor administration might be protective for CDI in ITR. Risks factors for CDI might be different in ITR compared to other populations; anatomical differences and medications administered in the post-transplantation period may affect intestinal microbiota.

The association of serum 25-hydroxyvitamin D levels with multiple sclerosis severity and progression in a case-control study from China

ObjectiveLow vitamin D levels had been shown to play a role in the pathogenesis of multiple sclerosis (MS). Currently, there is little information regarding the correlation between levels of vitamin D and MS in Chinese. This study aimed at detection of association between serum 25-hydroxyvitamin D [25(OH) D] concentrations and MS and its relation to the disease severity in Chinese. MethodsThe present study was a case-control type, it included 141 patients with definitive MS on the basis of ‘McDonald’ criteria and 282 age-sex matched controls. All patients were clinically evaluated including disease severity using expanded disability status scale (EDSS) score and progression index (PI). Serum 25(OH) D measurements were performed at baseline. ResultsThe median serum level of 25(OH) D in patients with MS was 15.9 (IQR, 11.4–24.4) ng/mL, which was significantly lower (P<0.0001) than those in healthy controls (20.6 [IQR, 15.3–27.7] ng/mL). There was a negative correlation between levels of 25(OH) D and the EDSS score (r=−0.549, P<0.0001). In multivariate conditional logistic analyses using dichotomous 25(OH) D levels, values less than or equal to 20ng/mL indicted higher risk of MS (OR 1.691, 95 CI: 1.058–2.394; P=0.024). Similarly, in binary logistic multivariate analyses using dichotomous 25(OH) D levels, values less than or equal to 20ng/mL indicted the MS high progression (OR 6.278, 95 CI: 2.662–15.659; P<0.001). ConclusionLow serum 25(OH) D levels were associated with increased activity and progression in Chinese patients with MS. Further analytical work is required to establish a causal association between vitamin D status and MS risk and progression.

Association between occupational psychological stress and metabolic syndrome

To investigate the association between occupational psychological stress and metabolic syndrome (MS) in Hui and Han populations in Ningxia, China. A 1:1 matched case-control study was performed. A total of 600 unrelated patients aged from 20 to 60 years who were clearly diagnosed with MS in General Hospital of Ningxia Medical University and Wuzhong People's Hospital from October 2011 to October 2012 were collected as the case group (MS group). A total of 600 healthy people who underwent a regular health examination in the same hospital during the same period were selected as the control group with matched gender, nationality, and age (≤ ± 3 years). The self-designed questionnaire was used to investigate the general situations and do the physical examination, and the fasting venous blood samples were collected for laboratory biochemical blood tests. The Occupational Stress Inventory (OSI) was used to investigate the subjects' occupational stress factors and stress levels. With the increase in stress levels, the levels of WC, FPG, TG, AST, and UA were increased, WHR, SBP, and DBP first increased and then decreased, and the level of HDL-C increased. There were statistically significant differences in these parameters between the two groups (P < 0.05 or 0.01). The occupational psychological stress test results showed that the total score of stress factors (t = 6.676, P < 0.05), workload (t = 10.269, P < 0.05), interpersonal relationship (t = 6.569, P < 0.05), family/work balance (t = 2.028, P < 0.05), cognitive load (t = 8.714, P < 0.05), and other scores (t = 2.838, P < 0.05) in the MS group were all significantly higher than those in the control group, but there were no significant differences in the scores of management role, work responsibilities, and organizational climate between the MS group and the control group (P>0.05). There were no significant differences in the total score of stress factors and the score of each factor between Hui and Han groups (P>0.05). The relative risks of MS in the people with moderate stress exposure were 2.325 and 2.331 times those in the people with mild stress exposure before and after adjustment for age, gender, education level, marriage status, smoking, and drinking, and the relative risks for MS in the people with severe stress exposure were 3.000 and 3.126 times those in the people with mild stress exposure. There were significant differences in the detection rates of abdominal obesity, high TG, low HDL-C, hypertension, hyperglycemia, and diabetes between the sub-groups with different stress levels in the MS group (χ² = 17.636, 8.514, 14.640, 14.280, and 33.323, P < 0.01). The results of multivariate conditional logistic regression analysis showed that the risk factors for MS were SBP, TG, LDL-C, UA, BMI, fasting blood glucose, family history of hypertension, family history of diabetes, and the level of psychological stress in Ningxia, and the protective factor for MS was HDL-C. The occupational psychological stress is closely associated with MS, and it is an environmental risk factor for MS. With the increase in the stress level, the detection rates of MS components and the relative risk for MS are significantly increased. And there is no significant difference in the level of occupational psychological stress between the Hui and Han nationality groups.

Related factors and prevalence for the essential tremor disease of Uygur residents in Hetian, Xinjiang UygurAutonomous Region

To explore the prevalence and related factors of essential tremor (ET) in permanent residents of Hetian, Xinjiang. By cluster random sampling, the local residents ( ≥ 10 years) at the age of 45 years and above in Hetian, Xinjiang received an epidemiological survey covering 1 city and 7 counties. Hetian City, Yutian County, Moyu County and Luopu County were randomly selected. According to the diagnostic standard of ET, the ET patients were screened face-to-face to understand the factors related to the pathogenesis of ET. And for this case control study, a ratio of 1: 1 was used to randomly select healthy subjects without ET as the control group. Both groups were matched with regards to gender, nationality and age ( ± 2 yr). The EpiData 3.1 software was employed. And the data were independently entered to analyze the prevalence of ET in various age groups. The statistical software SPSS 19.0 was used for single factor analysis and multivariate conditional Logistic regression analysis. P < 0.05 was statistically significant. A total of 5 932 patients responded to the questionnaire and there were 216 cases of ET patients. The total prevalence rate of ET was 3.64% in those aged over 45 years old and the prevalence rate over 45 years of age was 3.76% for males and 3.52% for females. The prevalence of 45-54, 55-64, 65-74 and ≥ 75-year old were 3.08%, 3.72%, 4.08% and 4.31% respectively. Multivariate conditional Logistic regression analysis showed: the pesticide exposure history (B = 2.664, χ(2) = 86.773, P < 0.05, OR = 14.347, 95% CI 8.192-25.127) and family history (B = 3.191, χ(2) = 61.430, P < 0.05, OR = 24.303, 95%CI 10.943-53.972) were associated with increased risk of ET while occupation, education, sports, social activities, drinking tea, eating habits and the incidence of ET had no obvious correlation. ET has a prevalence rate of 3.64% in Hetian, Xinjiang, And it has a rising trend with advancing age. The pathogenesis of ET is probably correlated with age, pesticide exposure history and family history. Thus theoretic rationales may be provided for early prevention and treatment of ET in the area.

Analyse related factors of impact and prognosis of 73 cases of severe hepatitis

A retrospective study was conducted to investigate the clinical features and prognostic factors of 73 cases of severe hepatitis. To summarize clinical features of 73 cases of severe hepatitis, grouping by etiology and pathogenesis. A retrospective analysis was performed to evaluate the relationship between biochemical characteristics (liver function, renal function, electrolytes, PTA, etc) and complications (hepatic encephalopathy, upper gastrointestinal bleeding, hepatorenal syndrome, ascites, abdominal infections, etc) and prognosis. (1) HBV infection alone accounted for 65.75%. Alcoholic liver disease, drug-induced liver injury, hepatitis E, autoimmune hepatitis, overlapping causes and other factors were five cases (6.85%), six cases (8.22%), two cases (2.74%), two cases (2.74%), seven cases (9.59%) and three cases (4.11%) respectively. According to the incidence rate, severity and underlying liver condition, subacute hepatitis, cases based on chronic hepatitis and on cirrhosis were 12 cases (16.43%), 11 cases (15.07%), 50 cases (68.49%) respectively. Clinical manifestations with or without hepatic encephalopathy accounted for 58.90% or 41.10%. (2) The highest mortality of severe hepatitis was alcoholic liver disease and patients on the basis of overlapping factors (66.67%), followed by autoimmune liver disease (50%). The mortality of HBV-related hepatitis was 18.75%. Overall mortality of 73 cases of severe hepatitis was 28.77%, of which cirrhosis group was higher than non-cirrhotic group (40% vs 4.3%, P = 0.002). The difference was statistically significant. Patients without hepatic encephalopathy had lower mortality than with hepatic encephalopathy (3.33% vs 46.51%). The mortality of patients with hepatic encephalopathy Stage III and IV was 72.73%. (3) Independent samples t test filtered nine factors associated with death, namely cirrhosis, upper gastrointestinal bleeding, hepatic encephalopathy, hepatorenal syndrome, serum creatinine, total bilirubin (TBIL), direct bilirubin (DBIL), albumin (ALB) and serum sodium. The results of multivariate conditional logistic regression analysis indicated that hepatic encephalopathy, serum creatinine levels were risk factors for death, whereas ALB as a protective factor. Hepatic encephalopathy, serum creatinine levels were risk factors for severe hepatitis death, But ALB was protective factor. Nucleotide analogs using was the main reason why the mortality of hepatitis B was as low as 18.75%.

Factors associated with overdose-caused mortality of HIV-positive patients who were on methadone maintenance treatment program

To study the factors that associated with the mortality of overdose on methadone maintenance treatment(MMT)among HIV-positive patients. A 1 : 1 matched case-control design was used to identify the relationship between factors related to demography, drug use, characteristics of treatment and the mortality of overdose. 110 HIV-positive patients who died of drug overdose from March 2004 to September 2012 were defined as cases. Controls were another 110 patients who were still alive and paired with the cases, according to the same gender, similar date of MMT initiation and from the same clinics. Multivariate conditional logistic regression analyses indicated that risk factors as sharing needles before enrolled in the MMT program(OR = 5.19, 95% CI:1.39-19.33), HIV infection because of injecting drug-use (OR = 3.08, 95% CI: 1.16-8.21), and off from the treatment before the end point of the program(OR = 2.54, 95% CI: 1.23-5.23)were associated with mortality caused by overdose. Higher adherence(OR = 0.31, 95%CI: 0.10-0.95)appeared to be associated with lower mortality when compared with the control group. In order to reduce the mortality rate, comprehensive intervention could be introduced to improve the compliance of retention on MMT among patients. Intervention efforts should be focused on those patients who shared needle/syringes.

Factors associated with gout in South Koreans: analysis using the National Health Insurance Corporation and the National Health Screening Exam databases

The aim of this study was to identify the factors associated with gout among South Koreans. A case control study of gout patients newly diagnosed between January 1, 2007, and December 31, 2008, and matching controls was conducted using the nationwide database (National Health Insurance Corporation and National Health Screening Exam (NHSE) database), which included the health-care records of 48.1 million individuals. Of 495,998 newly diagnosed patients, we included 18,123 who were ≥40 years old and had an NHSE before diagnosis of gout. To elucidate the factors associated with gout, multivariate conditional logistic analyses were performed. Gout was associated with drinking ≥1/week (p < 0.001), drinking ≥1 bottle of soju/session (p < 0.001), high body mass index (BMI) (p < 0.001), high blood pressure (p < 0.001), high total cholesterol (p < 0.001), proteinuria (multivariate odds ratio (OR) = 1.75; 95 % confidence interval (CI) = 1.53-2.00), and an elevated uric acid (multivariate OR = 1.54; 95 % CI = 1.22-1.94). Exercise frequency was not significantly associated with gout. Prediabetic blood sugar level (100-125 mg/dL) was associated with gout in the univariate analysis, but not in the multivariate analysis. Diabetic blood sugar level (≥126 mg/dL) was associated with a decreased odds of gout (multivariate OR = 0.79; 95 % CI = 0.73-0.86). Our nationwide South Korean study showed that frequent and excessive alcohol consumption, high BMI, high blood pressure, high total cholesterol, proteinuria, and high uric acid are associated with gout.

A logistic regression analysis of risk factors of ectopic pregnancy

Objective To identify possible risk factors of ectopic pregnancy.Method The clinical data of early pregnancy,including 176 cases of ectopic pregnancy and 1784 cases of normal pregnancy was retrospectively analyzed by univariate analysis and multivariate conditional logistic regression analysis from January 2009 to December 2010.Result The multivariate analysis showed that the risk factors of ectopic pregnancy were abortion,pelvic infectious history,ectopic pregnancy history,multiple sexual partner and low BMI.Conclusions We should strengthen health care education to child-bearing age women,reduce pelvic infection and abortion,avoid multiple sexual partner and weight,which may reduce the ectopic pregnancy rate. Key words: Ectopic pregnancy; Logistic regression analysis; Risk factors

The Risk of Bladder Cancer in Korean Diabetic Subjects Treated with Pioglitazone

BackgroundThere is growing concern regarding the increased incidence of bladder cancer in diabetic patients using pioglitazone. This study aimed to investigate the association between bladder cancer and the use of pioglitazone in Korean diabetics.MethodsThis retrospective, matched case-control study included a case group (n=329) of diabetic patients with bladder cancer who presented at the Severance Hospital from November 2005 to June 2011. The control group consisted of patients without bladder cancer (1:2 ratio matching for sex and age, n=658) who were listed on the Severance Hospital diabetes registry.ResultsThe percentage of subjects who had ever used pioglitazone was significantly lower in the case group than in the control group (6.4% vs. 15.0%, P<0.001). Multivariate conditional logistic analysis revealed that independent factors affecting bladder cancer were smoking (odds ratio [OR], 11.64; 95% confidence interval [CI], 6.56 to 20.66; P<0.001), coexisting cancer (OR, 6.11; 95% CI, 2.25 to 16.63; P<0.001), and hemoglobin levels (OR, 0.78; 95% CI, 0.69 to 0.88; P<0.001). The OR of the history of pioglitazone use was 2.09 and was not significantly different between the two groups (95% CI, 0.26 to 16.81; P=0.488).ConclusionA relationship between pioglitazone use and incidence of bladder cancer was not observed in Korean diabetic patients. This suggests that the risk for bladder cancer in Korean diabetic subjects treated with pioglitazone might be different from that of Caucasian populations. Large-scale, well-designed and multi-center studies are needed to further evaluate this relationship.

Risk factors of surgical interventions in patients with esophageal foreign bodies

To investigate the risk factors of surgical interventions in patients with esophageal foreign bodies(EFBs). Forty-three cases with EFBs underwent surgical interventions from January 1962 to January 2011 in Department of Thoracic Surgery at the Tangdu Hospital were enrolled in the study group. Forty three cases with EFBs who received non-surgical treatment in the same hospital and during the same period matched by gender and age(the age difference between the paired patients was 5 years or less) were selected as the control group. Clinical data including type of EFBs, duration of impaction, location of EFBs, complications associated with EFBs were collected. Univariate and multivariate conditional logistic analysis were used for risk factors analysis. Univariate conditional logistic analysis showed that type of EFBs, duration of impaction, location of EFBs, and complications associated with EFBs were risk factors of surgical interventions in patients with EFBs(P<0.05). Further multivariate conditional logistic analysis showed that type of EFBs(sharp EFBs) was the independent factor of surgical interventions in patients with EFBs(P=0.043; OR=29.228, 95% CI:1.114-766.686). Physician should pay more attention to patients with sharp EFBs. Whether the patients need surgical interventions or not should base on factors including duration of impaction, location of EFBs, and complications associated with EFBs.

Environmental risk factors and clinical phenotype in familial and sporadic primary blepharospasm

Although environmental and genetic factors may contribute to the etiology of blepharospasm, their relative contribution in causing familial and sporadic blepharospasm is unknown. First-degree relatives of 122 patients with primary blepharospasm were examined with a validated 2-step diagnostic procedure, including a screening questionnaire and examination of some relatives. Examiners were blinded to the questionnaire data for family history of probands. Data for demographic and clinical features, prior ophthalmologic complaints, and nondecaffeinated coffee intake were collected from probands before family investigation. Dystonia was diagnosed in 27 relatives from 23 families (20% rate of family history for dystonia). No significant differences were found between familial and sporadic cases in the frequency of coffee drinking and eye diseases or in sex, age at onset, or tendency to spread. Multivariable conditional logistic analysis testing of 67 case patients and 127 family-matched unaffected siblings yielded a significant positive association between blepharospasm and prior eye diseases (adjusted odds ratio [OR] 2.5; 95% confidence interval [CI] 1.1-6.1; p = 0.03) and a significant inverse association between case status and ever coffee drinking (adjusted OR 0.23; 95% CI 0.1-0.8; p = 0.02). The new information from this large family-based study on primary blepharospasm strongly supports eye diseases and coffee as risk factors for blepharospasm. The finding that the 2 environmental exposures exerted a similar influence on familial and sporadic blepharospasm, together with the convergent phenotypic expression in familial and sporadic cases, implies that familial and sporadic blepharospasm probably share a common etiologic background.

Relationship between the polymorphisms of UGT1A6 genes and anti-tuberculosis drug induced hepatic-injury

To investigate the relationship between the polymorphisms of UGT1A6 genes and anti-tuberculosis drug induced hepatic-injury (ADIH). 202 cases and 239 controls were collected and a case-control study was conducted. Information on related risk factors of tuberculosis was collected. The genotypes of UGT1A6-19T/G, UGT1A6-308C/A and UGT1A6-541A/G genetic polymorphisms were detected by polymerase chain reaction and restriction fragment length polymorphism technique (PCR-RFLP) in patients received anti-tuberculosis therapy. The Hha I, Dpn II and Nsi I enzyme were employed. Univariate and multivariate conditional logistic analyses were conducted using SPSS13.0 for windows software. The allele frequency of gene UGT1A6-19T/T, UGT1A6-19T/G, UGT1A6-19G/G, GT1A6-308C/C, UGT1A6-308C/A, UGT1A6-308A/A, UGT1A6-541AA, UGT1A6-541A/G and UGT1A6-541G/G in ADIH group were 51.5%, 39.6%, 8.9%, 52.0%, 40.6%, 7.4%, 57.9%, 33.7%, 8.4% and 71.1%, 25.5%, 3.3%, 79.1%, 19.2%, 1.7%, 79.5%, 19.2%, 1.3% in control group, respectively. Univariate analysis demonstrated that the frequency of UGT1A6-19T/G, UGT1A6-308C/A and UGT1A6-541A/G genotype in cases were significantly higher than that in controls (P less than 0.05). A positive association is found between UGT1A6 genotype and the occurrence of ADIH. The synergetic effect is proved on susceptibility to pulmonary tuberculosis between UGT1A6 mutant genotypes.

A 1:2 Case-control Study of Tap2/HLA-DR9 Gene Polymorphism with Esophageal Cancer in Kazakh

Objective To evaluate the association between Tap2379/Tap2665 genetic polymorphisms/ HLA-DR9 immune-associated gene and esophageal cancer(EC) in a high incidence Kazakh of Xinjiang.Methods A case-control study was conducted with 194 cases of EC and 388 controls.Tap2379/Tap2665 genotypes were detected by PCR-RFLP and HLA-DR9 allele gene were identified by PCR.The conditional logistic regression model was performed in this study.Results Tap2379 genotype frequencies of esophageal cancer group was different from the controls(χ2=18.247,P0.05,OR=2.347,95%CI:1.587~3.471);Tap2665 genotype did not find this difference(χ2=2.175,P0.05,OR=1.317,95%CI:0.919~1.899);HLA-DR9 allele positive of case group was different from the controls(χ2=13.443,P0.05,OR=2.343,95%CI:1.486~3.693).Multivariate conditional logistic regression analysis showed: Tap2379 genetic polymorphisms/ HLA-DR9 gene and history of esophageal or stomach disease were risk factors of Kazakh esophageal cancer.The interaction analysis showed Tap2379 genetic polymorphisms with HLA-DR9 allele gene significantly increased risk to the development of esophageal cancer 5.302(95%CI:2.363~11.900).Conclusion Tap2379 genetic polymorphisms and HLA-DR9 allele gene are important risk for EC,Tap2665 genotype did not found this action.Tap2379 and HLA-DR9 showed an additive risk to develop esophageal carcinoma.

The interaction analysis of genetic and behavioral factors on the occurrence of acute coronary syndrome

Objective To explore the the interaction analysis of genetic and behavioral factors on the occurrence of acute coronary syndrome. Methods This study consisted of 134 subjects between June 2009 and Dec.2009 from affiliated hospital of Jining Medical University, All subjects underwented selective coronary angiography or coronary artery CT. Coronary artery disease based on the results of coronary angiography or coronary artery CT that at least one coronary artery diameter reduction of more than 50% and fulfilled the diagnostic criteria of ACC/AHA. 84 patients with acute coronary syndrome and 50 controls, and general informations, current disease history,past medical history, related be havioral factors were collected. DNA was extracted from acute coronary syndromepatients and healthy control subjects, stored in -20 ℃. The genotype of CFH Y402H was detected by polymerase chain reaction and restriction fragment length polymorphism(PCR-RFLP) methods in acute coronary syndrome patients and controls. PCR amplification products was verificated by electrophoresis on agarose gel. Deviation of genotype distribution form Hardy-Weinberg equilibrium was assessed using x2 test in each group. Univariate and multivariate conditional logistic analyses were conducted in the end. Results The results showed that smoking history (P=0.000, OR =4.894,OR 95% CI:2.537 ～9.441 ), alcohol drinking history(P= 0.008,OR =2.879,OR 95% CI: 1.499 ～ 5.528 ), hypertension (P = 0.000, OR = 4.222, OR 95% CI: 2.195 ～ 8.123), sports activities (P =0.002,OR =0.333, OR 95% CI:0.188 ～ 0.589 ), salt intake (P= 0.006, OR = 0.457, OR 95% CI:0.287 ～0.727 ), character(P = 0.000, OR = 0.385, OR 95% CI :0.247 ～ 0.600 ) stress of occupations (P = 0.015, OR =2.118, OR 95% CI: 1.278 ～ 3.511 ) were associated with acute coronary syndrome of Northern Chinese Han population. Smoking history(P = 0.010, OR = 6.084, OR 95% CI: 1.543 ～ 23.988), hypertension (P= 0.024, OR =2.821, OR 95% CI: 1.143 ～ 6.595 ), sports activities (P= 0.004, OR = 0.297, OR 95% CI:0.130 ～ 0.678 ), personality(P= 0.011, OR = 0.435, OR 95% CI:0.229 ～ 0.829 ) were significantly associated with acute coronary syndrome in multivariate conditional logistic analyses after adjusting other factors. Conclusions Smoking history,hypertension, personality are risk factors of acute coronary syndrome of Northern Chinese Han population. Butsports activities is protective factors. Key words: Coronary artery disease; Behavioral factors; Genetic Polymorphism